Individual
LOI LE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17000 MEDICAL CENTER DR, BATON ROUGE, LA 70816
(225) 755-4396
(225) 755-4998
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
(318) 441-1050
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
320261
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2016
Last updated
09/23/2019
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